Case Study For Diabetic Retinopathy

Why do we treat diabetes? There are a number of downstream events associated with abnormal blood glucose levels. If glucose levels are managed properly, the complications associated diabetes can be controlled, and sometimes completely prevented. The main problem with having more than the normal amount of glucose circulating in the blood stream is the effect that excess glucose can have on both large and small blood vessels (DTC, 2004). Micro-vascular and macro-vascular problems associated with diabetes can be seen in the heart, eyes, kidney, legs and feet. Diabetic patients are twice as likely to suffer from a mycocardial infaraction, twenty-five times more likely to suffer blindness, and seventeen times more likely to suffer kidney failure compared to a non-diabetic (DTC, 2004). Because of great number of risks associated with abnormal blood glucose levels, diabetes is aggressively treated to improve the quality of life and prevent complications in patients.

Perivasculitis is an “inflammation of a sheath surrounding the tissue”1. In class we discussed the differences between perivasculitis and periflabitis. Perivasculitis should be white because of the inflammation and the white blood cells then spilling out. The Prefix ‘peri’ means around, or on the outside of the tissue. Retinal vascular sheathing is “sheathing or cuffing of blood vessels and vitreous cells”. The swelling or ‘cuffing’ of blood vessels in the retinal layer is a serious condition and is often associated with vasculitis. Finally, a retinal hemorrhage is “abnormal bleeding of the vessels in the retina”2. Retinal hemorrhages can be caused for a variety of reasons such as injuries like forceful blows or accidents and falls, as well as adverse health conditions. We know that the loss of vision can be largely attributed to the excess debris that is currently located in the eye, the debris being blood that is leaking out. Our case states that he has no previous trauma however, proving that there is an ulterior cause to the acute onset of the

As discussed in Dr. Fink’s lecture, high blood pressure can result in retinal damage. This retinal damage can present as hemorrhages, exudates, or with a component of papilledema (CP, 145). According to Lilly, this retinal damage produced by hypertension is termed hypertensive retinopathy. More often than not, the retinopathy can be seen on physical exam but is asymptomatic to the patient. However, the clinical presentation can help to further classify the nature of the patient’s hypertension.

This article goes in detail about the complications of Type 2 Diabetes, on how hyperglycemia damages the vascular system leading to microvascular disease and macrovascular disease. The complications of microvascular disease are diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. On the other hand, with macrovascular disease includes Cardio Vascular Disease (CVD), such as Atherosclerosis. Furthermore, the article gives recommendations of treating Type 2 Diabetes and the prevention of its health related complications with medication, screening, diet, and exercise.

Retinal vein occlusion is the second leading cause of vascular disorder after diabetic retinopathy.1 Retinal vein occlusions are classified into 3 categories depending on the location of the thrombus formation; branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), and hemi retinal vein occlusion (Hemi-RVO). 7 BRVO is considered to be the most common among the retinal vein occlusions.6 BRVO occurs more often in men than women. Asians (5.7 per 1000) and Hispanics (6.9 per 1000) are at greater risk of developing BRVO than other ethnicities.6 The age range of patients diagnosed with retinal vein occlusion ranges from young as 14 years of age to old as 92 years of age, with 51% of patients being older than 65 years.3 Advancing age is an important risk factor for developing retinal vein occlusions. Prevalence of retinal vein occlusions in 40-49 years old is 1.57 per 1,000, 4.58 per 1,000 in 50-59 years old, 11.11 per 1,000 in 60-69 years old, 12.76 per 1,000 in 70-79 years old, and 10.32 per 1,000 in those older than 80 years.6

The first stage in the patients is called non-proliferative diabetic retinopathy (NPDR), the signs are not visible to the eye and there are no symptoms. Patients will have 20/20 vision in this type of case. To detect non-proliferative diabetic retinopathy the only way is by fundus photography in which microaneurysms where microscopic blood-filled bulges in the artery walls can be seen. Fluorescein angiography can be done to see the back of the eye if there is reduced vision. Reduction or overfilled retinal blood vessels can be perceived clearly and this is called retinal ischemia due to the lack of blood flow.

Diabetes is associated with an increased risk of developing primarily vascular complications that contribute to morbidity and mortality of diabetic patients. Poor glycaemic control leads to vascular complications that affect large (macrovascular), small (microvascular) vessels or both. Macrovascular complications include coronary heart disease, peripheral vascular disease and stroke. Microvascular complications contribute to diabetic neuropathy (nerve damage), nephropathy (kidney disease) and retinopathy (eye disease).

One of many major diabetic health complications is retinopathy. Retinopathy is the scarring of the retina, which is caused by a lack of oxygen reaching the blood vessels in the retina. As a result, the retina grows new but abnormal blood vessels that leak blood and causes scarring. Retinopathy is the leading cause of blindness in adults.

1. Red – retinal arterioles, hemorrhaging, neovascularization, vascular anomalies, vascular tumors, retinal breaks, holes in retinoschisis, cilioretinal artery, and inner portion of thin areas of retina

Do you know what the leading cause of blindness is in Americans from ages 20 to 74? It is diabetes an illness that changes the way the body breaks down and absorbs sugars. These changes, doctors feel, take away oxygen that the retina needs. (The retina is the back layer of the eye and it is where sharp images are formed.) When this happens’ some small blood vessels may become weak and break, vision problems occur when this blood leaks into the areas around the retina. Diabetes can also cause glaucoma and cataracts. Glaucoma is a disease that causes a lot of pressure in the eye because too much fluid builds up. Cataracts, on the other hand, cloud the lens of the eye and this makes a person feel like he or she is looking through a grimy window.

There are even more categories which are gestational diabetes, diabetes LADA, diabetes MODY, double diabetes, type 3 diabetes, steroid induce diabetes, brittle diabetes, secondary diabetes, diabetes insipidus, and juvenile diabetes. Diabetes can lead to major complication such as heart and blood vessel disease consisting of heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. Nerve damage such as neuropathy. Kidney damage such as nephropathy later requiring kidney transplant. Eye damage which damages the blood vessels of the retina. Skin conditions the leaves patients at higher risk from bacterial and fungal infections. Impartially type 2 diabetes increase risk for Alzheimer’s disease which is shown to be related to insufficient blood sugar control.

Mr. Ramcharan is well known to me. He presents with a history of proliferative diabetic retinopathy with status post vitrectomy in his right eye. We have been following him for a new diabetic related vitreous hemorrhage in his left eye of three weeks duration. He feels his vision is unchanged overall.

Diabetic Retinopathy is treatable if caught in time, but if it is not diagnosed it can lead to blindness. Diabetics should have regular eye exams to prevent serious eye diseases, such as cataracts, glaucoma, and macular degeneration.

There are many different procedures that can be taken for the diagnosis of diabetes. A series of light flashes, each at a different wavelength is used to excite various proteins in the eye, each according to a particular length and the proteins emit fluorescent light. The pattern of light emissions reflects the distribution of carious proteins, which changes according to various psychological conditions (Scientific American Medical 22). This new method is based on synchronous fluorescent spectrometry, which combines a detector with a light source to measure the intensity of light emitted by proteins in the eye from each wavelength shown into the eye. A computer then compares the patient's peaks and valleys of such measurements with corresponding spectra form normal and diabetic eyes. Any one of the following three tests shows the

Diabetes Mellitus is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. It is a disease which is caused by the insufficient insulin secretion or decrease in the peripheral effects of insulin. It is a serious problem in terms of morbidity and mortality. The hyperglycemia is associated with long term damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels. It’s associated with many complications which includes blindness of the eyes and amputations of the extremities. It is also associated with neuropathy, retinopathy, and cardiovascular diseases which lead to mortalities.